FACTORS AFFECTING THE THICKNESS OF REPLACEMENT LAYER ON MEDIUM CLAY

Soil replacement is a common technique that can be used to increase the soil bearing capacity and reduce the expected settlement. The thickness of replacement layer depends on many factors such as: the applied stress, original soil properties, material of replacement layer and the cost of foundation works. However, until now the practical thickness of replacement is usually selected based on soil experts’ experience. This study proposed an optimization model to assist geotechnical engineers in predicting the optimum thickness and material type of replacement layer that satisfy the main design requirements, i.e. bearing capacity, consolidation settlement and cost considerations at the same time. The Evolutionary solving method that uses a variety of genetic algorithm and local search methods was used to solve the research problem. Furthermore, the effect of the thickness and properties of clay layer and the depth of ground water table on determining optimum type and thickness of replacement soil were investigated. The study evaluated the relationship between the replacement layer thickness and the total direct cost of foundation works and found that, the notion of increasing replacement thickness to decrease cost limitlessly was not viable and an optimal thickness was usually achieved.

Resource Use and Costs Associated to the Initial Phase of Treatment for Patients with Colorectal Cancer Receiving Post-Surgery Chemotherapy: A Cost Analysis from a Healthcare Perspective

Background: To estimate the resource use and costs associated to the initial phase of treatment for colorectal cancer in Iran. Methods: A retrospective study was conducted using routinely collected data within Electronic Health Records System (SEPAS), a national database representing public hospitals in Iran between March 20, 2016 and March 19, 2017. Primary end points included healthcare resource use, direct medical and non-medical costs of care in the 12-month study period. Results: The study population included 657 patients with colorectal cancer who underwent surgery and the follow-up chemotherapy. We estimated a total direct cost of $21,407 per patient. The results indicated that direct medical costs were primarily driven by inpatient hospital care, followed by surgery, chemotherapy, and diagnostic services. Conclusion: The initial 12-month of treatment for colorectal cancer, including surgery and the follow-up chemotherapy, is resource intensive. The total direct costs associated to the disease are remarkable, with Inpatient hospital services being the main contributor followed by surgery and chemotherapy.

Costs comparison of treating diabetic macular edema with aflibercept, ranibizumab or dexamethasone at 1 year in France (INVICOST study)

Purpose: INVICOST, a medico-economic analysis, compared costs of managing treatment-naive patients with diabetic macular edema (DME) receiving intravitreal injections (IVIs) of aflibercept (AFL), dexamethasone implant (DXI) or ranibizumab (RAN) over 1 year. Methods: Healthcare resource use and associated costs were estimated using individual patient data from INVICTUS, a prospective, open-label, monocentric study. Healthcare costs comprised direct medical costs such as drug acquisition and administration, consultations and ophthalmological procedures. Costs were assessed from the French National Health Insurance perspective using published national tariffs expressed in 2019 euros. Results: Of the 60 treated eyes, 48 had no treatment switch; 14 received AFL, 19 received DXI and 15 received RAN. AFL-treated eyes received an average of 6.5 IVIs, DXI-treated patients received 2 IVIs and RAN-treated received 6.8 IVIs. All treated eyes received an initial prescription for adjunctive ocular medications and 349 follow-up procedures were performed including an average of 3.9 optical coherence tomography and 3.2 retinography procedures per eye. Average total direct cost of per-eye treatment was €4516 (€1128–€8257). Average cost was €5782 for eyes treated with AFL, €2779 with DXI and €5536 with RAN. Drug therapy was the cost driver: €4394 (76%) for AFL, €1915 for DXI (69%) and €4268 (77%) for RAN. Conclusion: The difference in total treatment cost is largely explained by the significantly lower frequency of IVI and annual cost of therapy with DXI, compared with AFL and RAN. INVICOST is the first study comparing treatment costs with AFL, DXI and RAN in France in current clinical practice.

Longitudinal cohort study of injury type, settings, treatment and costs in British Columbia youth, 2003–2013

BackgroundIn 2010 in British Columbia (BC), Canada, total injury costs per capita were higher among youth aged 15–24 years than in any other age group. Injury prevention efforts have targeted injuries with high mortality (transportation injuries) or morbidity (concussions). However, the profile and health costs of common youth injuries (types, locations, treatment choices and prevention strategies) and how these change from adolescence to young adulthood is not known.MethodsParticipants (n=662) were a randomly recruited cohort of BC youth, aged 12–18, in 2003. They were followed biennially across a decade (six assessments).ResultsSerious injuries (defined as serious enough to limit normal daily activities) in the last year were reported by 27%–41% of participants at each assessment. Most common injuries were sprains or strains, broken bones, cuts, punctures or animal bites, and severe bruises. Most occurred when playing a sport or from falling. Estimated total direct cost of treatment per injury was approximately $2500. In addition, 25% experienced serious injuries at three or more assessments, indicating possible differences that warrents further investigation.ConclusionsThe occurence and health cost of common injuries to youth and young adults are underestimated in this study but are nevertheless substantial. Ongoing surveillence, awareness raising, and prevention efforts may be needed to reduce these costs.

Outcomes Following Implementation of a Hospital-Wide, Multicomponent Delirium Care Pathway

BACKGROUND: Delirium is associated with poor clinical outcomes that could be improved with targeted interventions. OBJECTIVE: To determine whether a multicomponent delirium care pathway implemented across seven specialty nonintensive care units is associated with reduced hospital length of stay (LOS). Secondary objectives were reductions in total direct cost, odds of 30-day hospital readmission, and rates of safety attendant and restraint use. METHODS: This retrospective cohort study included 22,708 hospitalized patients (11,018 preintervention) aged ≥50 years encompassing seven nonintensive care units: neurosciences, medicine, cardiology, general and specialty surgery, hematology-oncology, and transplant. The multicomponent delirium care pathway included a nurse-administered delirium risk assessment at admission, nurse-administered delirium screening scale every shift, and a multicomponent delirium intervention. The primary study outcome was LOS for all units combined and the medicine unit separately. Secondary outcomes included total direct cost, odds of 30-day hospital readmission, and rates of safety attendant and restraint use. RESULTS: Adjusted mean LOS for all units combined decreased by 2% post intervention (proportional change, 0.98; 95% CI, 0.96-0.99; P = .0087). Medicine unit adjusted LOS decreased by 9% (proportional change, 0.91; 95% CI, 0.83-0.99; P = .028). For all units combined, adjusted odds of 30-day readmission decreased by 14% (odds ratio [OR], 0.86; 95% CI, 0.80-0.93; P = .0002). Medicine unit adjusted cost decreased by 7% (proportional change, 0.93; 95% CI, 0.89-0.96; P = .0002). CONCLUSION: This multicomponent hospital-wide delirium care pathway intervention is associated with reduced hospital LOS, especially for patients on the medicine unit. Odds of 30-day readmission decreased throughout the entire cohort.

Health expenditure among the outpatient of type-2 diabetes in selected hospital of Kathmandu district: A cross-sectional study

Introduction Pocket (OOP) expenditure is the dominant financing mechanism in low and middle-income countries. In these countries, the prevalence of diabetes has been rising more rapidly, leading to various microvascular complications, thus increasing the risk of dying prematurely. Methods A cross-sectional - comparative and hospital-based study was carried out in which OOP expenditure of diabetic patients treated in public and private hospitals was compared. A total of 154 diabetic patients i.e.77 in each type of hospital were selected purposively in consultation with attending physicians and staff. Face to face interview was done on a diabetic patient with a minimum of one year of illness using a structured questionnaire. Lorentz curve and concentration curve were prepared using the income and expenditure of the patients. Result Among 154 patients, 97.4% of patients had paid out of pocket for the treatment of diabetes. The mean direct cost per month was NRs. 7312.17 in public and NRs. 10125.31 in a private hospital. The direct medical cost had a higher share in total direct cost i.e. 60.5% in public and 69.3 % in a private hospital. Medicine cost had a higher percentage share (50.9%) in public hospital and laboratory cost had a higher percentage share (68%) in a private hospital. Conclusion The direct medical cost was higher in a private hospital as compared to a public hospital. All the income groups have to pay a similar amount of money for the treatment i.e. economic burden for the treatment of disease was found higher for the poor people as there was no financial protection mechanism.

Oral anticoagulants for the treatment of venous thromboembolism and non-valvular atrial fibrillation: a cost analysis

Objective: To analyze the total direct cost of anticoagulant therapies indicated for the chronic treatment of patients with non-valvular atrial fibrillation (AF) and the acute treatment of venous thromboembolism (VTE) in the perspective of a tertiary teaching hospital and the national public health system. Methods: Therefore, the review of the treatment regimens that included all the oral anticoagulants based on nationals and internationals guidelines. The cost data were extracted and performed the simulation of the costs of pharmacological therapy and exams for monitoring therapeutic goals. The time horizon was defined by 365 days for AF and 90 days for TEV. Results: The treatment cost of 90 days in VTE was: rivaroxaban (USD $82,96 to USD $156,15), apixaban (USD $110,25 to USD $123,11), edoxaban (USD $106,56 to USD $265,15), dabigatran (USD $150,71 to USD $249,98) and warfarin (USD $54,94 to USD $159,66). While the treatment cost of AF was: rivaroxaban (USD $270,35 to USD $508,89), apixaban (USD $414,86 to USD $463,26), edoxaban (USD $402,41 to USD $477,78), dabigatran (USD $414,86 to USD $416,24) and warfarin (USD $20,03 to USD $43,54). Conclusion: Warfarin presented the lowest treatment cost for both comorbidities. However, although direct oral anticoagulants (DOACs) are always associated with higher price ranges, were observed price ranges in VTE treatment where DOACs proved to be economically more advantageous than warfarin, still requiring complete economic assessments.

Direct costs of rescue procedures to manage vascular access complications in conventional hemodialysis

ABSTRACT Objective: To measure the average direct cost of procedures performed by health professionals, in a Dialysis Center, for the management of complications of vascular access for hemodialysis. Method: Quantitative, exploratory-descriptive case study type research. The average direct cost was calculated by multiplying the time spent by health professionals by the unit cost of direct labor, adding this to the input costs (materials/ medicines/solutions). Results: The following average direct costs were obtained: US$0.72, US$2.00 and US$1.41 for “administration of easy-to-dilute, difficult-to-dilute, and undiluted antibiotics”, respectively; $2.61 for “central venous catheter dressing with topical antibiotic”; $48.05 for “alteplase infusion”; US$183.68 for “insertion of central venous catheter for hemodialysis”; and $1.31 for “arteriovenous fistula puncture”. Conclusion: Material and drug costs significantly contributed to the composition of the average total direct cost of most procedures.

Determinants of Medical Direct Costs of Care among Patients of a Memory Center

Background: Alzheimer’s disease and related diseases (ADRD) are a major cause of health-related cost increase. Objectives: This study aimed to estimate the real medical direct costs of care of patients followed at a memory center, and to investigate potential associations between patients’ characteristics and costs. Design: Cross-sectional analyses conducted on matched data between clinical data of a cohort of patients and the claims database of the French Primary Health Insurance Fund. Setting: Memory center in France Participants: Patients attending a memory center with subjective cognitive complaint Measurements: Medical or nonmedical direct costs (transportation) reimbursed by the French health insurance during the one year after the first memory visit, and socio-demographic, clinical, cognitive, functional, and behavioral characteristics were analyzed. Results: Among 2,746 patients (mean ± SD age 79.9 ± 8 years, 42.4% of patients with dementia), the total direct cost was on average € 9,885 per patient during the year after the first memory visit: € 7,897 for patients with subjective cognitive complaint, € 9,600 for patients with MCI, and € 11,505 for patients with dementia. A higher functional and cognitive impairment, greater behavioral disorders, and a higher caregiver burden were independently associated with a higher total direct cost. A one-point decrease in the Instrumental Activities of Daily Living score was associated with a € 1,211 cost increase. The cost was higher in patients with Parkinson’s disease, and Lewy body disease compared to patients with AD. Diabetes mellitus, anxiety disorders and number of drugs were also significantly associated with greater costs. Conclusions: Higher real medical direct costs were independently associated with cognitive, functional, and behavioral impairment, diabetes mellitus, anxiety disorders, number of drugs, etiologies as well as caregiver burden in patients attending a memory center. The identification of factors associated to higher direct costs of care offers additional direct targets to evaluate how interventions conducted in patients with NCD impact direct costs of care.

Economic Burden of Viral Acute Respiratory Infections in Upper-Middle-Income Countries: Protocol For A Systematic Review

Objective: To synthesize the available data on the economic burden of Coronavirus Diseases 2019 (COVID-19), Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), Influenza-Like Illness (ILI), Respiratory Syncytial Virus (RSV)-related Acute Respiratory Infection (ARI), and Parainfluenza Virus type III (PIV3)-related ARI in Upper-Middle-Income Countries (UMIC), highlighting its major causes and comparing direct costs among nations. Study design: Systematic review, following the recommendations proposed in the Cochrane Handbook, but with some adaptations from previous economic studies. Review question: Is there any economic cost of viral ARI in UMIC? Types of studies to be included: Partial economic evaluation, such as Cost-of-Illness (COI) studies and burden of illness/diseases, database analysis, observational reports (cross-sectional studies, and prospective and retrospective cohort), and economic modelling studies that discuss one of the viral ARI in UMIC. No year of publication filter or language limit will be applied. Search databases: MEDLINE, EMBASE, LILACS, CINAHL, EconLit, CRD Library, MedRxiv, and Research Square. Moreover, hand searches of the bibliographies of included studies and relevant reviews identified during the screening process will be undertaken to identify any additional relevant study for inclusion in our review. Synthesis of results: Qualitative analysis. We will focus on the overall economic burden of the diseases on health systems and population; total direct cost; the contribution of different cost components to the economic burden (e.g. pharmacological therapy, hospitalization); comparative assessments of costs analysis across geographical location and time horizon; and current research gaps. Moreover, we intend to identify, when presented, prevalence and incidence rates of each disease. PROSPERO registration number: CRD42020225757.